gastro-intestinal

?
  • Created by: birungi1
  • Created on: 27-03-18 20:20
What is Coeliac disease?
Autoimmune disease - Tx eliminating symptoms, gluten free diet
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Diverticular
causes low abdominal pain, accompanied with fever, general malaise
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What is the treatment for diverticular disease?
High fibre diet - tx of symptomatic diverticular disease, uncomplicated - low residue diet and bowel rest, complicated - hospitalisation IV ABx and bowel rest, prevention tx- insufficient evidence for rifaximin, antispasmodics, mesalazine and probiot
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Treatment for crohns disease?
CS / aminosalicylates, ADD 2 or more exacerbations in 12 months: azathioprine/mercaptopurine MAINTENANCE: azathioprine/ mercaptopurine or methotrexate DIARRHOEA: loperamide or colestyramine
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Treatment for ulcerative colitis?
aminosalicylates with or without CS, MAINTENANCE: aminosalicylate
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When should aminosalicylates be discontinued?
blood disorders
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How should you monitor aminosalicylate renal function?
monitor before, 3months in to TX then annually
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What is the side effect of mesalazine?
dizziness
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What is mesalazine contra-indicated in?
blood clotting abnormalities
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Mesalazine brands
asacol > 18years, pentasa and salofalk > 6 years other brands mezavant, octasa
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What is the side-effect of olsalazine?
watery diarrhoea
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Advisory and cautionary label for olsalazine?
take with or just after food
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Indication for sulfasalzine?
ulcerative colitis, crohns disease, rheumatoid arthritis
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Side-effect for sulfasalzine?
blood disorders, cough, dizziness, fever, insomnia, taste disturbances, tinnitus
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What colour does sulfasalzine turn urine?
yellow/ orange
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What is vedolizumab contra-indicated in?
severe active infection
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When should you discontinue vedolizumab?
severe infusion related reactions
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What are the non-drug tx for IBS?
increase physical activity, eat regular, fresh fruit at most 3portions/day, 8cups water/day, decrease caffeine
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Treatment of IBS
Laxatives or anti-motility drugs
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Treatment are not working for IBS?
Linaclotide - not responded to laxatives from different classes + had constipation for at least 12months
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What is linaclotide contra-indicated in?
GI obstructions, IBD
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Once linaclotide is opened when should it be discarded?
18weeks
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What is tedglutide used for?
short bowel syndrome
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When should you seek medical attention for tedglutide?
weight gain, swollen ankles, dyspnoea
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moviprep, klean-prep and picolax are contra-indicated in what?
acute severe colitis, gi obstruction, toxic megacolon
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what the side-effects of the moviprep, klean-prep, picolax?
abdominal pain (reduced by taking preparations more slowly), nausea and vomiting, abdominal distention
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what renal function should picolax be avoided in?
less than 20ml/min
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Picolax can increase what electrolyte?
magnesium
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laxatives can decrease what electrolyte?
potassium
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Treatment for short duration constiptaiton?
bulk forming or osmotic
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Treatment for chronic constipation?
bulk, plus osmotic , plus stimulant
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Treatment failure in chronic constipation
prucalopride licenced in women, lubiprostone --> (at least 2 laxatives at highest tolerated doses are not effective for at least 6months)
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When should you review prucalopride and lubiprostone?
prucalopride after 4weeks and lubiprostone after 2weeks
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What is the dose of prucalopride in renal impairment?
1mg OD < 30ml.min
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What are the side-effects on prucalopride?
dyspepsia, flatulence, dizziness, diarrhoea, abdominal pain
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Lubiprestone is contra-indicated in what?
gi obstruction
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What are the side-effects of lubiprestone?
abdominal discomfort, diarrhoea, dyspepsia, hyperhidrosis, flatulence, headache
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When should you discard the remaining capsules for lubiprestone?
after 4weeks
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Treatment for opioid induced constipation?
osmotic / stimulant (avoid bulk)
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Treatment for constipation in pregnancy?
bulk, osmotic, stimulant can be used (senna avoid near term, biscodyl)
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Treatment for constipation in children?
macrogol, stimulant --> stool remains hard --> lactulose / docusate
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Treatment for faecal impaction in adults?
depends on consistency, high dose macrogol
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Treatment of faecal impaction in children?
macrogol slowly increase dose, after 2 weeks no result --> stimulant and lactulose
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Bulk forming laxatives?
methycellulose, isphagual husk (fybogel), sterculia
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What are bulk forming laxatives contra-indicated in?
faecal impaction, colonic atony, intestinal obstructio, difficulty swallowing
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What are the side effects of of bulk forming laxatives?
abdominal distension, flatulence, gi impaction, obstruction, hypersensitivity
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How do you decrease nausea from lactulose?
administration with water, fruit juice/ meals
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What are the side-effects of lactulose?
flatulence, cramps, abdominal discomfort
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What is macrogol contra-indicated in?
CD, UC, paralytic ileus, intestinal obstruction,
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Side effects of Macrogol?
abdominal distention, abdominal pai, flatulence, nausea
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Docusate is contra-indicated in what?
intestinal obstruction
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What are the side-effects of docusate?
abdominal cramp, low potassium, rash
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What age is liquid paraffin contra-indicated in?
less than 3 years
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What are the contra-indications of stimulant laxatives?
acute IBD, severe dehydration, intestinal obstruction
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What colour does co-danthramer and co-danthusate turn urine?
red
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Senna can be sold to the pulic above what age?
12years old
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Prolonged use of senna and picosulfate can lead to what?
low potassium
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What is the advisory and cautionary label for naloxegol?
take on empty stomach
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co-phenotrope can be sold to what age OTC?
over 16 years old
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What are the contra-indications of co-phenotrope?
gi obstruction, intestinal atony, myasthenia gravis, paralytic ileus
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What are the contra-indications for loperamide?
active UC
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What are the side-effects of loperamide?
dizziness, flatulence, headache, nausea
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What age can loperamide be sold to the public?
diarrhoea > 12years, IBS > 18years
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What is racecadotril contra-indicated in?
Antibiotic associated diarrhoea
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What are the side-effects of racedotril?
Headache
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When should you discontinue racecadotril?
skin reactions
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Bismuth containing antacids can be what?
neurotoxic --> encephalopathy, constipating
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What is simeticone ?
antifoaming agent
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What are aliginates?
form a raft that floats on the surface contents
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Name the antacids which are low in sodium?
co-magaldox (maalox, mucogel), altacite , co-simalcite
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What are altacite and co-simalcite contra-indicated in?
hypophosphataemia (and magnesium containing only)
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What are the side effects for sucraflate?
constipation
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What age is sucraflate unlicensed in?
under 15 years old
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What can sucraflate interact with?
enteral feeds --> benzoar formation (you can separate by 1 hour)
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What are the side-effects of H2 antagonist?
dizziness, headache, diarrhoea
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What age can you sell H2 antagonists OTC?
over 16 years old, supply for 2 weeks
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What are the side-effects of cimetidine?
malaise
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What are the side-effects of famotidine?
constipation
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What should you do if a person has renal impairment and they are taking ranitidine?
half the dose if less than 50ml.min
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What are the side-effects of misoprostol?
diarrhoea
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What are the effects of misoprostol on pregnancy?
uterine stimulant - associated with abortion, teratogenic risk in first trimester
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What are the cautionary and advisory label for misoprostol?
take with or just after food
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Proton pump inhibitors have a MHRA alert on what?
SLE, risk of fractures
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What are PPI's cautioned in ?
gastric cancer
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What are the side-effects of PPI's?
headache, diarrhoea, constipation, flatulence, gi obstruction, flatulence, nv
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What are the side-effetct for omeprazole?
impotence, agitation
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What are the side-effects for pantropazole?
hyperlipidaemia, weight changes
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What are the side-effects of rabeprazole?
cough, influenza like symptoms, rhinitis
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What age can PPIs be sold OTC?
over 18years for 4 weeks
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Losec can be mixed to provide infusion, how is it stable in each solution?
NaCl: 12hours, glucose: 3hours
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Treatment for GORD?
mild: alignate --> PPI, review after 4 to 6 weeks, decrease dose for maintenance
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What medication can you use for drug allergy?
chlorphenamine
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Mebeverine and alverine are contra-indicated in what?
paralytic ileus
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What are the side-effects for mebeverine?
allergic reactions, rash, urticaria, angioedema
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What are the side-effects for alverine?
dizziness, dyspnoea, headache, hepatitis, nausea, wheezing,
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Treatment for cholestatic pruritis?
colestyramine
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Treatment for inborn errors of primary bile acid synthesis?
cholic acid
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What is ursodeoxycholic acid used to treat?
dissolution of gallstones, biliary cirrhosis
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What are the side-effects of ursodeoxycholic acid?
diarrhoea
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What are the cautionary and advisory label for urseodeoxycholic acid?
take with or after food
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What are the side-effects of terlipressin?
abdominal cramps, arrhythmia, bradycardia, diarrhoea, headache, hypertension
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When can you use anti-obesity drugs?
BMI> 30, failure to achieve realistic reduction, or BMI > 28 with associated risk factors
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When should you discontinue orlistat?
after 12 weeks, weight loss is less than 5%
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What is orlistat contra-indicated in?
cholestasis, chronic malabsorption syndrome
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What are the side-effects of orlistat?
abdominal distension, anxiety, faecal incontinence
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Treatment for anal fissure?
tear / ulcer in the lining of the anal canal, Tx: bulk forming, osmotic
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Treatment for haemorrhoids in pregnancy?
soothing preparations NOT local anaesthetics or CS
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What is pancreatin?
lipase, amylase and protease, administered with meals and snacks (creon)
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Diverticular

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causes low abdominal pain, accompanied with fever, general malaise

Card 3

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What is the treatment for diverticular disease?

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Card 4

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Treatment for crohns disease?

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Card 5

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Treatment for ulcerative colitis?

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